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Pharmacology > module 4 anti-rheumatic drugs > Flashcards

module 4 anti-rheumatic drugs Flashcards

1
Q

drugs for osteoarthritis

A 
analgesia
- APAP
- NSAIDS
- COX-2 inhibitors 
inflammation if present
- NSAIDS
- COX-2 inhibitors
- intra-articular corticosteroids
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2
Q

rheumatoid arthritis drugs

A

ASA at inflammatory doses: rarely used d/t AE
symptomatic therapy
- NSAID
- corticosteroids- systemic, intra-articular
Prevent or slow progression
- DMARDs

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3
Q

corticosteroid use

A 
anti-inflammatory
life-threatening complication of RA: 
- vasculitis 
bridge time to onset of DMARD
pulse therapy for acute flare ups 
intra-articular therapy for acute inflammation
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4
Q

Corticosteroid AE

A 
hyperglycemia
cataracts
glaucoma
aseptic necrosis of weight bearing joints
osteoporosis
cushing syndrome
adrenal suppression 
Na and H2O retention
CNS side effects
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5
Q

corticosteroids with mineralcorticoid activity

A

cortisone
hydrocortisone
prednisone
prednisolone

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6
Q

mineralcorticoid activity

A

promotes Na/H2O retention

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7
Q

Disease modifying antirheumatic drugs (DMARDs)

A

standard of care
ideally used when Dx of RA is established
prevent or slow progression of joint destruction
- relatively toxic, potent, very expensive

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8
Q

conventional DMARD drugs

A 
hydroxychloroquine
methotrexate
azathioprine
gold
penicillamine
sulfasalazine
leflunomide
minocycline
cyclophosphamide
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9
Q

biologic DMARDs

A 
etanercept
infliximab
adalimumab
certolizumab
golimumab
tocilizumab
rituximab
abatacept
anakinra
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10
Q

DMARD monitoring

A

may take 3-6mo for response
response is often incomplete
- continue NSAID
Monitor ROM, ADL

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11
Q

DMARD seldom used and their AE

A

gold, penicillamine

  • high toxicity
  • myelosuppression
  • proteinuria
  • stomatitis
  • rash
  • altered taste
  • visual changes
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12
Q

Azathioprine (PO)

A

also for crohn’s disease
prodrug for mercaptopurine
immunosuppressant
reserved for aggressive disease or serious complications

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13
Q

azathioprine AE

A

myelosuppression
hepatotoxicity
rash
infection

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14
Q

hydroxychloroquine (PO)

A

primarily for mild RA

also an antimalarial drug

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15
Q

hydroxychloroquine AE

A

some GI upset

retinopathy: rare
- eye exam every 6-12 months

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16
Q

sulfasalazine (PO)

A

mild to moderate RA
also for crohn’s and UC
becomes: sulfapyridine and 5-aminosalicylic acid in intestine

17
Q

sulfasalazine AE

A

GI upset
rash
bodily fluids can turn yellow-orange
can bind to iron and dec. absorption

18
Q

sulfasalazine precaution

A

pt on antibiotic; intestinal flora may be destroyed, reducing conversion to active form.

19
Q

leflunomide (PO) MOA

A

inhibitor of pyrimidine synthesis

-> altered lymphocyte activation and dec. inflammatory response

20
Q

leflunomide AE

A 
hepatotoxicity
reversible alopecia
GI distress
Preg: X 
-- cholestyramine can quickly lower drug levels in pts who wish to become pregnant
21
Q

Methotrexate (PO, IM, subQ) MOA

A

folate antagonist -> purine biosynthesis inhibition, cytokine production inhibition, adenosine production stimulation -> anti-inflammatory effect

22
Q

methotrexate AE

A

GI upset
megaloblastic anemia
- pt should receive folic acid replacement
hepatotoxicity

23
Q

Biologic DMARD advantage

A

no routine laboratory monitoring

24
Q

biologic DMARD disadvangates

A

risk of infections and malignancy
- temp. suspend tx if occur
very expensive
Parenteral: injection site reactions common

25
Q

Biologic DMARDs: TNF-a blocker drugs

A 
etanercept 
infliximab
adalimumab
certolizumab pegol
golimumab
- may use in combo with DMARD
26
Q

biologic DMARD MOA

A

downregulate or antagonize TNF-a, a key cytokine in RA

27
Q

biologic DMARD AE

A

infections
- fungal infections
- active TB, and reactivation of latent TB
- bacterial infection
- viral infection
- opportunistic infections
lymphoma and other malignancies in children and teens

28
Q

Rituximab (biologic DMARD)

A

depletes B-cells which have been shown to be responsible for inflammation in RA
- use when pt fails traditional DMARD and anti-TNF agents

29
Q

rituximab AE

A

fatal infusion reactions
severe mucocutaneous reactions
PML

30
Q

Abatacept (biologic DMARD)

A

inhibits T cell activation

- use when pt fails traditional DMARD and anti-TNF

31
Q

anakinra (biological DMARD)

A

antagonized IL-1 receptors, a proinflammatory cytokine

  • use when pt fails traditional DMARD and anti-TNF
  • can use in combo with DMARD but not other anti-TNF
32
Q

tocilizumab (biologic DMARD)

A

inhibits IL-6

use when patient fail anti-TNF drugs

33
Q

tocilizumab AE

A

serious risk of infections

  • invasive fungal infection
  • active TB, and reactivation of latent TB
  • bacterial infection
  • viral infection
  • opportunistic infections
34
Q

methotrexate benefits

A

cheap
well tolerated
take effect within one month
- most commonly used DMARD

Pharmacology (78 decks)

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